New Hampshire Reasonable Accommodation Request Form

State:
Multi-State
Control #:
US-216EM
Format:
Word; 
Rich Text
Instant download

Description

This form may be used to assist a company in determining to what extent a reasonable accommodation is required.
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FAQ

Needed accommodations may include providing: Accessible training sites; Training materials in alternate formats (e.g., large print, Braille, audiotape, or electronic format) to accommodate a disability; and. Sign language interpreters or captioning.

Dear Mr./Ms. (Contact at Human Resources Department): I work at (Company Name) as a (Your Job Title) and have been in this position since (Date). I am writing to request that you provide (list accommodation needed here) as a reasonable accommodation under the ADA.

How to Handle an Employee's Request for an ADA AccommodationStep 1: Determine Whether the Employer Is Covered by the ADA.Step 2: Ensure a Policy and Procedure Exist for Handling Accommodation Requests.Step 3: Determine Whether the Employee with a Disability Is "Qualified"Step 4: Initiate the Interactive Process.More items...

Steps for Requesting AccommodationsComplete a Getting Started Form. This basic form consists of contact information and five brief questions.Provide DSS with current disability related documentation.Meet with DSS for an intake appointment.Request Your Accommodations Each Term.

Dear Employer: I am writing to request a reasonable accommodations for my disability/disabilities. I am an employee of/am applying for a position at Public Entity. I am also subject to a stay-at-home order / at higher risk for COVID-19 complications because of my disability.

What to Include in Your Reasonable Accommodation LetterYour name and position.The date.Information about your disability.A request for accommodation.Accommodation ideas.Medical information.

There is no need to mention the ADA or use the phrase reasonable accommodation. Requests for reasonable accommodation do not have to be in writing and can be requested in a face-to-face conversation or using any other method of communication.

What types of accommodations are generally considered reasonable?Change job tasks.Provide reserved parking.Improve accessibility in a work area.Change the presentation of tests and training materials.Provide or adjust a product, equipment, or software.Allow a flexible work schedule.More items...

Sample Accommodation Request LetterIdentify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

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New Hampshire Reasonable Accommodation Request Form